Provider Demographics
NPI:1912460189
Name:MARINO, VINCENZO GIUSEPPE (DDS)
Entity Type:Individual
Prefix:
First Name:VINCENZO
Middle Name:GIUSEPPE
Last Name:MARINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 LATONA RD STE B100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2723
Mailing Address - Country:US
Mailing Address - Phone:585-663-2130
Mailing Address - Fax:
Practice Address - Street 1:550 LATONA RD STE B100
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2723
Practice Address - Country:US
Practice Address - Phone:585-663-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0610941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice